Provider Demographics
NPI:1215020169
Name:OJEDA, ALONSO R (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:ALONSO
Middle Name:R
Last Name:OJEDA
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3023
Mailing Address - Country:US
Mailing Address - Phone:951-823-0441
Mailing Address - Fax:951-823-0448
Practice Address - Street 1:6767 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3023
Practice Address - Country:US
Practice Address - Phone:951-823-0441
Practice Address - Fax:951-823-0448
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44777207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G447770Medicare PIN
CAA49747Medicare UPIN